Interview with Dennis Van Vliet Candidate for Presidient, American Academy of Audiology

AO/Beck: Hi Dennis. Congratulations on your candidacy for the AAA Presidency. That is an extraordinary honor. As always, it's a pleasure spending time with you. Let's start with your professional background please.

VAN VLIET: Sure. I came out of California State University at Fullerton, which didn't have a well-defined audiology program at all! Nonetheless, there were a number of us interested in audiology and we all ended up with good entry-level training and employment positions. Mike Metz was my mentor and he was responsible for me going into audiology. My first job was at the House Group in Los Angeles. I was there for a couple of years which gave me the opportunity to gain a broad base of experience with a variety of different pathologies.

AO/Beck: When did you graduate with your master's?

VAN VLIET: That was in January, 1976.

AO/Beck: Okay. And then where did you go from House?

VAN VLIET: I was an educational audiologist for two years with the Los Angeles County Superintendent of Schools.

AO/Beck: That must have been an interesting time to be there.

VAN VLIET: Yes it was. In fact it was right after PL-94-142, now the IDEA legislation, kicked in. It was a good and exciting time and I enjoyed it very much. I went from there, to the Director of Audiology at Newport Language, Speech, and Audiology Center. I was with them for ten years. In 1989, I started my own private practice in the city of Yorba Linda. I did that for ten years and then joined up with HEARx, which is now Hear USA. They purchased my practice and now my current job includes management of 22 offices in Southern California and 10 in Washington State.

AO/Beck: Dennis, please tell me a little bit about your experience with the AAA Board. When did you first get on the Board?

VAN VLIET: I was on the AAA Board from 1994 to 1997. I also served as the AAA Convention Chair in 1998 for the Los Angeles convention. I should also mention that I was on the American Board of Audiology (ABA) Board of Directors from 1997 to 2001.

AO/Beck: And I believe the reason the ABA exists is to independently promote and manage board certification in audiology?

VAN VLIET: That's correct. The idea was to respond to requests from the membership to develop a meaningful board certification that would address not only an entry-level qualification but some measure of ongoing competency.

AO/Beck: Dennis, if you become president-elect, what are the issues you see facing the Academy and what would you like to push forward as your presidential agenda?

VAN VLIET: I think the role of the Academy is to provide the foundation for audiology to move ahead into a fiscally independent profession that can receive third-party reimbursement and can, in general, function independently, rather than working on the coat-tails of some other profession. Integral in this effort is our transition to a doctoral level profession, and support of research and academic professionals.

AO/Beck: Can you address the issue of relationships between the professional national groups?

VAN VLIET: I'm one who tries to build consensus as much as possible within groups. Sometimes that's a difficult thing to do, but we are so few in number that it doesn't make sense for us to be working at cross purposes within our profession. Whenever possible, we need to work together toward common goals. Having said that, there are times when consensus cannot be built, and we need to be strong enough to pursue an agenda that is best for audiology.

AO/Beck: Let's talk a little bit about ethics. Where are we as a profession and where are we as the Academy? Certainly, Dr. Loavenbruck has spearheaded an interest in ethics during her term as president.

VAN VLIET: It's an interesting time. In our national political scene, we see Executive Branch decisions that have the appearance of conflicts of interest; the new Senate Majority Leader, Dr. Bill Frist, is a major shareholder in medical and pharmaceutical companies, yet the official ruling seems to be there are no conflicts of interest and he can vote on healthcare issues. So we certainly get some mixed messages about where we're going as a society, regarding what's appropriate and ethical.

As a member of AAA President David Fabry's Ethics in Audiology Task Force in 2001, I was given the opportunity to look carefully at our business and professional practices both from a historical and contemporary perspective. In the AAA, we have a well defined Code of Ethics. I believe we need to examine the things we do to make sure that we are operating in an ethical manner. That is, in a large part, up to the individual. The organization is not here to dictate and direct behavior, but is here to help individuals address ethical issues. It is the responsibility of the AAA to provide guidelines, while not necessarily being a police force for the profession. I think we have a process that we need to go through so all of our members are up-to-date on what is, and what is not, ethical behavior; and what may appear to be ethical, or appear to be unethical behavior.

AO/Beck: Is there a particular litmus test you use in your personal practice or personal life when something feels like it may be a conflict of interest? In other words, at what point can you say this is how I know whether or not I should or shouldn't do it?

VAN VLIET: There are different tests that people talk about. The Mike Wallace test is defined as: Would you be comfortable if Mike Wallace and the 60 Minutes news cameras came bursting in the door when you were about to perform a certain action? In other words, would you be comfortable if your patients were fully aware of my business relationships, business ties, or business practices? Others say that as long as the audiologist is doing what is in the patient's best interest, it is ethical. I think I am comfortable as long as I follow certain guidelines, and the patient is comfortable. Maybe that's the litmus test: Comfort after full disclosure. We'll have to see how these issues evolve. In the meantime, they are certainly interesting and worthy topics.

AO/Beck: Let's switch topics a little. Do you think there is a need for an independent accreditation program for colleges and universities?

VAN VLIET: Absolutely. Right now there a clear problem because we have a membership organization tied to an entry-level credential tied to a certification program, tied to another profession. I think an independent body that looks specifically at audiology programs and is completely independent of a membership organization is where accreditation needs to be.

AO/Beck: What's your thought on the CCC-A?

VAN VLIET: I am no longer a member of ASHA. I think the CCC-A had a very important part in our history. Certainly it's an adequate entry-level credential and it has standards that have stood the test of time. But going beyond that, I think there needs to be some measurement of competency that goes beyond payment of fees to maintain an appearance of currency. Of course, ASHA is now starting to demand CEUs to maintain the CCC-A. That was a good move and I applaud that. I think specialty certification is probably the direction that will make the most sense for us in the long term.

AO/Beck: Please tell me more about that, Dennis. I think I understand the reasons for specialty certification, but I'm not convinced it's a good thing. Doesn't it have the potential of dividing and separating us further? What is the benefit to the profession and to the patients?

VAN VLIET: Good question. I think that within certain areas of audiology, such as pediatrics, cochlear implants and perhaps industrial audiology, very specific skill sets are needed. Even a well-qualified entry-level audiologist may not have these skills. I think additional educational and clinical exposure within these identified areas is necessary. Individuals with specialty certification will have received additional training, additional experience, and will have met a higher standard so the consumer can have assurance they're dealing with somebody who is clearly beyond the entry level in terms of their level of preparedness to perform these tasks. Are those individuals holding themselves above the rest of the profession? Well, I think not. That would be an unfortunate way to look at it. I think it's simply a measure, or if you will, an acknowledgement of additional training to insure the highest level of care for the patient.

AO/Beck: Okay. I understand that. But my concern is that some audiologists without specialty certification may be viewed as perhaps not qualified to do this or that, despite the fact that their license allows it. I can see that becoming an issue in the future, and I certainly hope I'm wrong!

VAN VLIET: In spite of the fact that our code of ethics states that Members shall maintain high standards of professional competence in rendering services, providing only those professional services for which they are qualified by education and experience. , I agree that perception may be a concern. On the other hand, I think we have a duty as a professional organization to make sure that we can provide the training and the recognition of that training for people that work in these highly specialized areas.

AO/Beck: Very good Dennis. And I know we're way into overtime here, but can we address one or two more issues before I let you run?

VAN VLIET: Sure, go for it.

AO/Beck: Can you please discuss your thoughts and concerns about our profession being tied to a product. In other words - Is audiology as a profession limited by it's connection to a product, specifically hearing aids?

VAN VLIET: That has concerned me for some time, and I'm conflicted because, like many audiologists, I'm right in the middle of it in the context of my current employment. The model under which many of us practice does tie reimbursement to a product. The problem goes beyond whether or not an audiologist charges additional for a hearing test or bundles the hearing test within the price of the hearing aid. The many hours of service we provide to our hearing aid clients are reimbursed by the one-time payment for the hearing aid. The effect of this practice is to put a much higher value on the product than it does on our services.

Let's imagine ourselves ahead some number of years: There is going to be a time when audiologists will be needed for assessment, for counseling, for a number of other things -- but we probably won't have hearing aids as we know them today!

I think now is the time to look carefully at the services we provide, and to start to bring those out from the shelter of being bundled under one price. The consumer may look at the hearing instruments as more of a commodity, and our services as a necessary piece to make use of the product. That may be best for the profession in the long run. I think we need to examine our current service delivery model carefully and then make decisions based on the facts of the realities of business today, and tomorrow. I think we need to stop hiding behind bundling and bring professional services out into the open. I believe that consumers should be fully informed in terms of what they are buying and we should much more carefully itemize what levels of service we're providing for them.

AO/Beck: Well I agree with that on some levels. But I think unbundling encourages price shopping.

VAN VLIET: Yes, that may happen, but price shopping is a reality for consumers today. We often have price shopping with bundled products as well. I don't think that behavior is going to change very much. The patient is either going to recognize the professionalism or they're not. It's very difficult for some patients, especially if they haven't met you, to really understand what we're doing and what the professional services are. My goal is to put the professional service component out front as a valued element.

AO/Beck: Okay. Last topic - doctoral education. Are you seeking a clinical doctorate?

VAN VLIET: Yes I am. I am currently enrolled in the Central Michigan program. I am done with my coursework and I take comps in January. If everything pulls together, I will be done in 2003.

AO/Beck: Oh, that's fantastic. Good for you. I'm proud of you for doing that. You've been in practice longer than I have, but I've been in almost 20 years, and going back to school is a difficult thing. How long has it taken you at CMU?

VAN VLIET: By the time I'm done it will be a little more than two years. The audiology classes were challenging, rewarding, and I learned a tremendous amount. As a professional, I looked at the doctoral education experience as rigorous and relevant. In spite of my professional activities over the past 27 years, reading journals, writing, speaking, and participating in continuing education, I have found the experience to be one of discovery and professional renewal. I am glad to have experienced the process, and I highly recommend it for other audiologists.

AO/Beck: Dennis, thanks for being so generous with your time. It really has been a pleasure speaking with you.

VAN VLIET: Thanks Doug. I appreciate the opportunity to address the Audiology Online readers.